EXPERIENCES OF CHILDHOOD TRAUMA CAN OFTEN LEAD TO ANXIETY DISORDER, AND THE FEAR THAT GOES HAND IN HAND WITH THIS, IN LATER LIFE. I THOUGHT, THEREFORE, I WOULD LIST A FEW SUGGESTIONS THAT CAN HELP US LEARN HOW TO DEAL WITH FEAR :

1) GET TO THE ROOT OF THE FEAR – often, when we are afraid of something, it is not the actual thing itself we are really afraid of, but what it represents to us on an unconscious level. Sometimes, if we take a little time to analyze the fears that we have, we realize that the thing we think we are afraid of is actually triggering a memory of something in the past which frightened us.

2) STOP AND ANALYZE AGGRESSION AND ANGER – some people seem to be angry all the time (in fact, that is not entirely inapplicable to me). Sometimes, displays of anger and aggression can be a mask for underlying feelings of powerlessness (again, some might argue this is not utterly untrue of old muggings here). Sometimes, then, we get angry in an attempt to hide (not just from others, but from ourselves) our inner feelings of fear.

3) OVERCOMING THE FEAR OF SUCCESS : this may sound a rather odd one, but, in fact, it is far from uncommon. It often exists only on a sub-conscious level. But why, I hear you ask, should somebody be afraid of success ? Well, there are generally taken to be two main reasons – the first is that sometimes we need to take risks in order to be successful, and many people don’t want to put at risk the limited success they may already enjoy. The second is that often people fear the pressures and responsibilities success can bring with it.

4) DESENSITIZATION : this is a technique whereby we expose ourselves to our fear in gradual stages to ‘get used to it’. A simple example would be someone who is afraid of heights. They may start off by going to the second floor of a building a few times and looking down from its balcony, and they would gradually progress to the 4th, then 6th, then 8th floor, and so on, until, by the end of the desensitization process, they are able to look over the balcony on, say, the 30th floor.

5) CREATE A PERSONAL MANTRA : people have been doing this for thousands of years ; ideally, by saying the phrase (whatecver it happens to be) it should make you feel strong and confident. The English comedy character Delboy, for example, has the mantra, ‘He who dares wins’, perhaps a rather silly example, although it was originally used by the elite British fighting force the S.A.S.

6) EDUCATE YOURSELF ABOUT YOUR PARTICULAR FEARS – this is one of the most important things you can do in relation to overcoming fears. You can start by researching just one or two fears. For the purpose, there are academic materials available on the internet. These will provide a wealth of knowledge about what causes them. Remember, knowledge is power – the more that you know about what is causing your fears, and the more you teach yourself strategies to overcome them, the less frightening they will become.

7) ASSUME THAT YOU WILL BE SUCCESSFUL – when undertaking a particular task, or when trying to solve a problem, ASSUME THAT YOU WILL SUCCEED AT IT. Research demonstrates that there is a positive correlation between levels of expectation of success and success itself. A negative attitude, in contrast, will put you at a disadvantage from the word go. A useful thing to do is to look into the ‘law of attraction’, or, alternatively, click here for ‘the law of attraction’ hypnosis download for sale from HYPNOTICDOWNLOADS http://www.naturalhypnosis.com/law-of-attraction-hypnosis?l=833159”

8) LIVE IN THE MOMENT – Of course, it is necessary for all of us to plan for the future ; however, thinking about the future too much can very easily become a source of fear. This is especially true for those of us who suffer from anxiety conditions. To avoid this, we can train ourselves to live more fully in the present, as a young child engrossed in play does so naturally (we find it harder as we get older). The more that we practice doing this, the easier it becomes.

9) STAY BUSY – When we are busy it is necessary for us to focus and concentrate on the task in hand and stops us having morbid thoughts. Busy fingers are happy fingers!

10) ENDURE A DIFFICULT SITUATION – By making yourself remain in a situation which makes you uncomfortable, such as, for example, an awkward and stressful social situation, you will usually find it becomes more tolerable and perhaps (god forbid!) enjoyable. Set yourself mini-endurance challenges like this – the more you are able to get through uncomfortable situations, the less anxiety provoking they will become.

11) ENGAGE A DIFFERENT PART OF THE BRAIN : this is a most effective method which has the effect of SHORT CIRCUITING THE FEAR RESPONSE. Using a higher level of brain function (e.g playing chess against a computer or even mentally running through some mental maths) will largely disengage the emotional part of the brain and engage, instead, a higher level of consciousness. Alternatively, try to mentally relive, in detail, a pleasurable past event from memory.

12) EXERCISE : Research has shown that getting moderate physical exercise (even as little as 20 minutes per day) is of enormous benefit to both physical and mental health.

13) TRY TO FIND HUMOUROUS ANGLES TO APPROACH PROBLEMS FROM : this is extremely good when dealing with fear as it is almost impossible to be frightened of something when you are laughing at it. The brilliant film director Woody Allen has said that his sense of humour acts as a defense mechanism (I recommend his films – a good one to start with is Manhattan).American comic genius Woody Allen

14) Don’t allow you fears to exaggerate a situation – try to consider the situation in which you find yourself in as realistic a way as possible. In particular, watch out for fears over-riding your rational mind (which is the main reason they become overwhelming. This used to happen to me – all the time and in a very extreme way.

15) DRINK LESS ALCOHOL – drinking large amounts of alcohol effects judgment and often causes fears – especially the next day when hung-over, spiral out of control. There is a danger of long-term, excessive drinking leading to delusions and paranoia.

16) REDEFINE YOURSELF – we are all changing every day (as our brain is changing day by day according to what it is experiencing and how it interprets what it is experiencing, there is nothing to stop us from consciously working on that change in a focused manner. Reducing fears, and leaving some behind altogether, can be one of those changes.

17) REMEMBER THAT FEAR IS, VERY OFTEN, JUST :

False

Evidence

Appearing

Real

Whenever you feel afraid it is worth repeating this mantra (if possible, out loud)

18) TRY TAKING SOME SMALL RISKS : In life, if we wish to make progress, it is necessary to take some risks. Obviously, though, large, foolish risks are to be avoided !

Many children who grow up in dysfunctional family homes find themselves living in a state of hypervigilance, never knowing how their parents are going to respond to them at any given time (for example, this is often the case in homes where one or both parents are alcoholics or in homes where the parents are subject to dramatic mood swings and outbursts of explosive rage (perhaps due to substance abuse or to mental illness). In other words, such children live in environments in which they are frequently exposed to severely stressful events but are unable to predict when such events will occur.

A study conducted by J.M Weiss (1971)was conducted to investigate the somatic (i.e. bodily) effects of unpredictable stressors on rats.

How was the study carried out?

In the study, the rats were split into two groups :

GROUP ONE : The rats in this group were given UNPREDICTABLE electric shocks (the stressor)

GROUP TWO : The rats in this group were also given electric shocks (each shock that the rats in this group received were of exactly the same intensity and duration as the shocks that the rats in group one received – HOWEVER, the shocks given to the rats in this group were PREDICTABLE (a warning signal was given immediately prior to the application of each shock).

So, to summarize :

GROUP ONE RATS WERE SUBJECTED TO UNPREDICTABLE STRESSORS

GROUP TWO RATS WERE SUBJECTED TO PREDICTABLE STRESSORS

Were The Somatic (Bodily) Effects On The Rats Different According To Which Group They Were In?

Yes. The rats in Group One (who were subjected to UNPREDICTABLE STRESSORS) suffered greater adverse somatic stress reactions than the did rats in Group Two (who were subjected to PREDICTABLE STRESSORS).

Somatic stress reactions shown by the rats included :

changes in body weight

stomach ulceration

effects upon plasma corticosterone concentration

Similarly, living in an environment in which one is exposed to unpredictable stress can seriously, negatively impact on a young person’s psychological develpopment. Indeed, studies show that parents who treat their children in harsh and unpredictable ways, especially when the child is in an emotionally distressed state, increase these children’s risk becoming emotionally deregulated and unable to cope effectively with stress.

Such children may also be placed at risk of developing various physical problems such as obesity.

STRESS INOCULATION

One method to help us overcome our vulnerability to the harmful effects of stress was developed by the psychologist Meicenbaum (1985) ; the method is a form of psychotherapy known as stress inoculation training (SIT).

Stress Inoculation Training:

This therapy is intended to help the individual prepare in advance for potentially stressful situations, increasing his/her resistance to stress, together with his/her ability to manage it.

Stress inoculation therapy (SIT) involves the patient undertaking three specific stages. These are as follows:

1) Conceptualization

2) Skills Acquisition and Rehearsal

3) Application and Follow Through

Let’s look at each of these in turn:

1) CONCEPTUALIZATION:

The patient is encouraged to view the stressor as a challenge to be overcome (as opposed to an insurmountable problem).

S/he is taught to differentiate between what can and what can’t be changed about this challenging situation what can, then to accept what can’t be changed and to focus what can be changed (such as his/her response to it).

S/he is also encouraged to become aware that anticipating not being able to cope with the challenging situation can frequently become a self-fulfilling prophecy.

2) SKILLS ACQUISITION AND REHEARSAL:

Once the patient has reconceptualized the potential stressor, s/he is taught skills intended to enable him/her to deal with it in the most effective manner possible. Skills s/he is taught will vary according to individual needs but may include:

The therapist also helps the patient rehearse for the upcoming potentially stressful situation(eg through visualization exercises and role play)

3) APPLICATION AND FOLLOW THROUGH:

This simply involves putting the above into practice. Sometimes the therapist may utilize a method known as systematic desensitization which involves the patient first being exposed to only a mildly challenging situation, then gradually being exposed to increasingly challenging situations until the patient has mastered his/her fear.

Several of the articles on this site have already examined the link between childhood trauma and anxiety. In this article, I want to consider one specific anxiety based disorder known as obsessive-compulsive disorder (OCD). When a person has this disorder, as its name suggests, s/he suffers recurring obsessions and/or compulsions. I define these below :

COMPULSIONS – behaviours or mental acts intended to reduce the anxiety the obsession causes (but which, in fact, actually makes the anxiety worse over the long-term). Any effect the compulsion has on reducing the anxiety created by the obsession is temporary.

I show below how thoughts, feelings and behaviours flow into each other to keep the symptoms of OCD going :

OBSESSIONS (intrusive thoughts or images related to contamination, sexuality, danger, morality etc) >>>>>DISTRESS (eg shame, fear)>>>>>COMPULSION (repetitive behaviours or mental acts aimed at reducing the anxiety created by the obsession)>>>>>TEMPORARYRELIEF>>>>>OBSESSIONS (intrusive thoughts or images related to contamination, sexuality, danger, morality etc)>>>>> (eg shame, fear)>>>>>COMPULSIONS (repetitive behaviours or mental acts aimed at reducing the anxiety created by the obsession)>>>>>TEMPORARYRELIEF>>>>> and so on…and so on…leading to chronic distress.

In order for a person to be diagnosed with OCD, the following criteria normally have to be met :

a) the obsessions and compulsions cause significant distress

b) the obsessions and compulsions significantly interfere with day to day functioning.

c) the behaviours engendered by the OCD take up about an hour a day or more

d) the person with OCD is aware, at least at some level, that his/her behaviours are excessive and illogical

It is, of course, necessary to get a diagnosis from a professional as opposed to trying to self-diagnose.

HOW PREVALENT IS OCD THROUGHOUT THE GENERAL POPULATION?

It is estimated that approximately 2-3% of the population will suffer from OCD at some point during their lives. However, this may well be an underestimate as many people choose to keep their condition a secret. Research indicates, however, that OCD is becoming increasingly common.

Whilst the condition can begin in childhood, its onset is more common in late adolescence. It seems to be equally common in both men and women. However, women are more likely to seek out treatment for the disorder.

OCD can be made worse by stress. Also, those who suffer from OCD often suffer from other conditions as well. These include :

It should also be noted that people often have multiple obsessions/compulsions and these can change over time.

Due to the amount of distress OCD causes, and its link to other serious psychological conditions, if a person suspects s/he suffers from it, it is very important to seek out professional advice.

OCD and the brain :

Brain scans have shown that the brains of people who suffer from OCD are different from people who don’t. These scans show :

there is overactivity in certain brain regions which include ;

– the basal ganglia

– the orbital frontal regions

– the caudate nucleus

Furthermore, it has also been shown that those who suffer from OCD have less serotonin (a neurotransmitter) available in the brain. Indeed, medication called SSRIs ( selective serotonin reuptake inhibitors) increase the amount of serotonin in the brain and can be an effective treatment for OCD.

Pure O (which stands for ‘purely obsessional’) is (at the time of writing) a little known term used to refer to a form of obsessive compulsive disorder (OCD) ; OCD, as we have seen from other articles that I have previously published on this site, is a disorder that we are at higher risk than average of developing if we have suffered from significant and chronic childhood trauma.

Spikes :

‘Pure O’ manifests as internal, mental rituals that involve a compulsion to obsessively ruminate upon, and to turn over and over in one’s mind, the same repetitive, disturbing thoughts ad infinitum. These intrusive thoughts, which the affected individual finds impossible to dismiss from conscious awareness, are sometimes referred to as ‘spikes.’

Typically, the content of these distressing, intrusive and unbidden thoughts center upon irrational fears of carrying out a behavior that are abhorrent to one and utterly contrary and antithetical to one’s set of values, ethics and morals such as rape, murder or, if one is religious, some terrible form of blasphemy.

Example Of Pure O :

Indeed, I once saw a documentary about a man who suffered from this condition. He was obsessed by the idea that he might commit murder whilst sleepwalking at night and took his concern so seriously that, as a result, he never went to sleep without first chaining his ankle, complete with padlock, to the metal bed-frame each night (however, the hypothetical question of whether he could, in theory, retrieve the key, open the padlock and then commit murder – all in his sleep – was left unaddressed!). In any event, he was no more likely to commit murder in his sleep than anybody else – his concern was what could be termed a ‘delusional concern’ and solely a symptom of his psychiatric condition as opposed to being based on any real, objective risk.

How Does Pure O Differ From Main Forms Of OCD?

Pure O differs from the main forms of OCD in so far as the rituals one feels compelled to carry out are mental, internal, and, therefore, hidden from others and (unless one chooses to confide in others about them) secret ; this contrasts with the rituals carried out by those suffering from the main forms of OCD that tend to be observable by others (such as compulsive hand-washing or checking doors, windows etc are locked and secure).

Statistics Relating To Pure O :

The onset of Pure O tends to be between the ages of approximately 13 years of age and 25 years of age. It has been estimated that it affects about one per cent of individuals. However, this could be an underestimate as it is probable that many individuals don’t realize that they have the disorder or do not wish others to know about it so keep it secret and never seek professional help.

TREATMENT FOR OCD

WHAT TREATMENTS ARE NORMALLY GIVEN?

Experts in the field of the treatment of OCD generally recommend cognitive-behavioural therapy (CBT) which is made even more effective if it is combined with medication – usually the medication will be an anti-depressant, although sometimes a benzodiazepam may be used.

Generally speaking, the anti-depressant is a long-term treatment, eg given for perhaps a minimum of a year, and up to a whole life-time, even if symptoms significantly improve (this is done in order to minimize the chances of a relapse occurring).

On the other hand, if the individual with OCD is prescribed a benzodiazepam, this will generally only be taken over a short period of time (eg a period when the symptoms are very acute) in order to minimize the risk of the individual with OCD becoming physically and/or psychologically dependent upon them (as they are addictive).

HOW EFFECTIVE IS TREATMENT?

If studies on the effectiveness of anti-depressants for the treatment of OCD are looked at as a whole, on average individuals with OCD who undergo such treatment significantly improve around about 45% of the time. Whilst any improvement is obviously extremely desirable, in general the improvements individuals make by taking anti-depressant medication are not great enough to eliminate the need for other treatments being given alongside.

As has already been referred to, cognitive-behavioural therapy (CBT) is usually the type of therapy to be used alongside medication – in fact, it is a specific type of CBT which is known as EXPOSURE WITH RESPONSE PREVENTION (which I’ll henceforth refer to as EWRP). As has also been mentioned, if symptoms are extremely severe then benzodiazepam may be prescribed over the short term before the EWRP can take place.

WHAT DOES EWRP ACTUALLY ENTAIL?

We have already looked at how sufferers of OCD have obsessive thoughts which cause them distress. What EWRP is designed to do is to help the individual TOLERATE SUCH DISTRESS. For, example, one common way in which OCD manifest itself is by making the sufferer inordinately and irrationally fearful of germs. Therefore, s/he may constantly be acutely anxious that his/her hands are ‘dirty’ and that this is potentially ‘highly dangerous’ – this, in turn. leads to constant compulsions to wash their hands in order to relieve their distressing and acute anxiety. However, the sense of relief is extremely ephemeral and the compulsion returns, perhaps leading the afflicted individual to wash his/her hands 100 times a day.

In the above example, the approach EWRP takes is to help the person tolerate the distress that his/her perception of having ‘dirty’ hands causes him/her by encouraging him/her not to wash them for a given period of time. As the person becomes better and more used to the anxiety caused by not washing them, the period of time can be gradually increased. The idea is that the person will become desensitized to the anxiety associated with unwashed hands.

On top of this, CBT can be used to help the individual challenge irrational thoughts which are connected to his/her OCD. For example, in the case described above, the individual could be helped to challenge thoughts such as ‘having any dirt on my hands is highly dangerous’ and to understand that the thought is an enormous exaggeration of any objective danger.

What Is Meant By Hypervigilance?

A person who is hypervigilant feels constantly ‘on edge’ , ‘keyed up’ and fearful. S/he experiences a perpetual sense of dread and of being under threat despite the fact, objectively speaking, there is no present danger. Indeed, the person affected in this way is so intensely alert to, and focused upon, any conceivable imminent danger that s/he may develop paranoia-like symptoms and frequently perceive danger in situations where no such danger, in reality, exists.

Nervous System

In physiological terms, the nervous system becomes ‘stuck’in an over-activated state and it is very difficult for the hypervigilant individual to calm him/herself sufficientlyto enable it to return to a normal level of activation ; instead, it becomes locked into the ‘fight or flight‘ mode (the hypervigilant person’s body is in a continuous state of preparedness to fight or flee because of the anticipation of threat the person feels).

Hypervigilane, Hyperarousal, Childhood Trauma And Complex PTSD :

Hypervigilance is one of the many symptoms of hyperarousal.

Hyperarousal, in turn, is a symptom of PTSD /Complex PTSD which are conditions linked to severe and protracted childhood trauma.

Other symptoms of hyperarousal may include :

insomnia (e.g. constant waking in night and finding it hard to go back to sleep)

LINK : One of the world’s leading experts on how trauma affects the body, and what can be done about it, is the author of ‘The Body Keeps Score’, Bessel van der Kolk, and his website can be found here : besselvanderkolk.net

We have already seen that, all else being equal, an individual who suffers significant childhood trauma is at greater risk than average of developing an anxiety disorder in adulthood. In this article, I will look specifically at health anxiety and what types of childhood experiences may put individuals at increased likelihood of developing it. With regard to this, the first question to answer, of course, is :

What Is Health Anxiety?

Health anxiety used to be referred to as hypochondria; however, this term is becoming increasingly obsolete due to its somewhat pejorative connotations. For a person to be diagnosed with health anxiety (and such a diagnosis, of course, can only be carried out by an appropriately qualified professional) s/he generally has to be preoccupied with thoughts centering around illness (i.e. a belief s/he is ill or an overwhelming conviction that s/he will imminently become ill) despite reliable, medical reassurances that this is not the case.

What Childhood Experiences Make It More Likely That An Individual Will Develop Health Anxiety?

First, individuals who suffered a serious illness as a child and were traumatized by the experience are at increased risk of developing health anxiety in adulthood.

Second, those who, in childhood, had a primary-carer who was excessively anxious about their health, or more generally overprotective, are at increased risk of developing health anxiety in adulthood.

Third, those who, in childhood, experienced a close family member (such as sibling, mother or father) being seriously ill are at increased risk of going on to develop health anxiety.

Fourth, people who, as children, had parents who excessively shielded them from the reality of health problems (e.g. parents who never talked about their own illnesses or the illnesses / deaths of other family members, including never allowing the child to attend funerals) are more likely to go on to develop health anxiety

Finally, growing up with parents who, to an excessive degree, feel the need to continually (and with excessive frequency) emphasize the vital and crucial importance in life of having one’s health.

Other Factors That Can Contribute To The Development Of Health Anxiety:

Childhood experience is not the only factor connected to the development of health anxiety in later life ; other factors that may contribute or be involved include :

Above : examples of the excessive ruminations that a person with health anxiety may have.

4) Genetic predisposition : it is possible some people may genetically inherit a tendency towards obsessive-like thinking.

Therapies :

Therapies available for the treatment of health anxiety include cognitive behavioral therapy (CBT) and trauma-focused therapy (CFT).However, sometimes (depending upon the individual’s particular constellation of psychological problems) other forms of psychotherapy may be more appropriate.

Also, because it is thought that serotonin-level abnormalities may sometimes be involved with health anxiety, antidepressants are sometimes prescribed for its treatment (under the guidance, of course, of an appropriately qualified professional).

Childhood Trauma And Social Isolation:

If, as a result of our childhood trauma, we develop, in adulthood, mental illnesses such as depression, anxiety, borderline personality disorder or complex post traumatic stress disorder, we are at greater risk than average of becoming socially isolated. Indeed, I have written elsewhere on this site about how, for several years, I saw virtually no-one apart from those I was forced to interact with (such as doctors, psychiatrists, pizza delivery-men, shopkeepers).

But why do people become so socially isolated? Below, I briefly explain some of the main reasons:

1) We may distrust others or feel fearful or vulnerable when around them

2) We may simply lack the energy it requires to interact with others, especially if it entails pretending to be cheerful

3) Anhedonia : we no longer derive pleasure from being in the presence of others

4) Misanthropy : we no longer like other people and have a very low view of humanity in general

5) Fear of how we might behave : for example, if we have problems with anger, we may fear becoming angry or (especially if we drink heavily in the company of others) violent

6) We may have deep – seated feelings of inadequacy, shame, inferiority or self-hatred and view ourselves as unfit to engage with ‘decent’ society

7) We might feel others look down on us for being mentallyill or feel self-conscious about symptoms such as agitation

8) We don’t want to talk about our illness / experiences that led to it and fear that others may pressure us to do so, or that they may say ignorant things like ‘why don’t you just get over it?’

9) Others may ostracizeus and turn their backs on us due to lack of understanding, lack of compassion or anunwillingness to be of emotional support

10) Complete breakdown of social confidence (especially if affected by ostracization – see number 9 immediately above).

11) Guilt – we might see ourselves as such a ‘bad’ and ‘dispicable’ person that we don’t allow ourselves to go out and enjoy ourselves

How Remaining Socially Isolated Can Lead To A Vicious Circle :

If we avoid mixing with others due to feelings such as anxiety, anger, depression and lack of confidence, the emotional pain of our isolation is likely to exacerbate these symptoms thus making it even harder to socialize and, ultimately, leaving us feeling like ‘misfits’ and ‘social pariahs’ and in a general state of despair.

Furthermore, without emotional stimulation or emotional ‘nourishment’ we can find that our feelings shut down and we feel emotionally numb/dead.

To help overcome a propensity to self-isolate, assertiveness training can help, as can anger management training if one’s problems are anger related.

Social Anxiety And Self Consciousness :

Self-consciousness, and concens about how others perceive us in social situations, both lie at the heart of social anxiety. At its worst, social anxiety can make interacting with others intolerably distressing, leading us to avoid social situations, or, as in my own case (especially in my teens, twenties, and, now I come to think of it, a not insignificant proportion of my thirties) resorting to the consumption of large volumes of alcohol in an attempt to ease social difficulties (once a certain amount is consumed, however, the difficulties can become immeasurably worse – an experience I am by no means a stranger to).

HOW DOES SELF-CONSCIOUSNESS MANIFEST ITSELF?

One of the main symptoms of self-consciousness is that we can become OBSESSED WITH WHAT WE BELIEVE OTHERS MIGHT BE THINKING OF US. The word ‘MIGHT’ in the last sentence is of great importance, however. Often, what we believe others MIGHT be thinking of us is not, in reality, what they are thinking at all; people, in very general terms, are very frequently indeed too preoccupied with their own worries and concerns to spend a lot of time dwelling on others. In other words, OFTEN, BECAUSE OUR TRAUMATIC CHILDHOOD EXPERIENCES LED US TO SEE OURSELVES IN A NEGATIVE LIGHT (maybe parents/step-parents treated us, as children, as though we were INTRINSICALLY BAD), we are prone, frequently, to fall into the trap of believing (FALSELY) that others, too, will always share a similarly jaundiced view of us.

We may also be fearful of how others may react to us. For example, if we experienced rejection as a child, we may have been ‘programmed’ to expect everyone, sooner or later, to reject us too. Of course, such an inference does not follow in any logical manner.

Social anxiety, then, frequently leads us to develop A DEEP FEAR OF SOCIAL INTERACTION. But what is it, precisely, that we actually fear? Research into this area suggests that, overwhelmingly, we fear how the social interaction will make us FEEL, rather than what may actually happen to us (someone being hostile, for example).

THE VICIOUS CYCLE THAT SOCIAL ANXIETY CREATES:

The fear generated by the social interaction can, and, very often, does, set up a VICIOUS CYCLE – THE MORE ANXIOUS WE FEEL, THE MORE DANGEROUS THE SOCIAL SITUATION SEEMS TO BE…SO WE FEEL YET MORE ANXIOUS…and so on…

2) Self-consciousness affects how we THINK about ourselves; for example:

– we may think that we are intrinsically unlikable (let alone lovable), worthless, uninteresting, peculiar and odd. We may even consider ourselves a ‘freak’.

3) Self-consciousness affects how we FEEL; for example:

– fearful and at risk– a sense of needing to escape or avoid the social situation– selectively picking up (psychologists have termed this ‘SELECTIVE ATTENTION’) on ‘negative’ reactions towards us from others, whilst, at the same time, dismissing any positive feedback we may be attracting (I put the word ‘negative’ in inverted commas for good reason: this is because, very often, our social anxiety disturbs our perceptions – we may IMAGINE that others are responding negatively, when, in fact, this is simply a result of us MISINTERPRETING SIGNALS FROM OTHERS (e.g. misinterpreting body language, facial expressions, tone of voice etc).

HOW WE CAN REDUCE OUR SELF-CONSCIOUSNESS:

The main thing that the EXPERTS IN THIS FIELD SUGGEST is to:

FOCUS MORE ON EXTERNAL EVENTS (ie what is going on around us) and less on INTERNAL EVENTS (i.e. how we feel and the negative thoughts that may be running through our head). It helps, then, in social situations, to DIVERT OUR ATTENTION AWAY FROM OURSELVES AND RECHANNEL IT ONTO THOSE AROUND US.

Self-consciousness can also impair our ability to concentrate and follow exactly what others are saying to us in a social situation (ie we might frequently lose the thread of the conversation); because of this, experts also advise that we try to INCREASE OUR CONCENTRATION ON PRECISELY WHAT OTHERS ARE ACTUALLY SAYING. It is also important to keep in mind that the danger we perceive social situations to represent is ALMOST INVARIABLY FALSE.

We need, too, to attempt not to dwell on any unpleasant feelings social interaction gives rise to in us; if we pay too much attention to, say, our sweating palms, things tend to only be made worse. Any unpleasant feelings, then, that social situations may cause us to experience, need to be seen for what they are – merely feelings which FALSELY ANTICIPATE DANGER WHERE NO REAL RISK OF DANGER EXISTS. We need to just accept the feelings, non-judgementally, and view them as the FALSE IMPOSTORS that they are – then we are in a position to simply let them ‘wash over’ us.

Social Anxiety And The ‘Acting As If’ Technique

Many people assume that confidence is something that you either have or you don’t ; however, this is not actually the case. It is not a case of either being born confident or not. Also, feelings of confidence are not fixed. A person may be confident in some areas of life (e.g. about a hobby, their work or the ability to play a sport or musical instrument etc, but not confident in others). So it is not a question of being a confident person or not. Rather, it is a question of which areas of life you are confident in already, and which areas of life you have the potential to be confident.

Feeling a lack of social confidence does not set a person apart, nor does it make them in any way inadequate or inferior. Indeed, many people who we think of confident may well, beneath the veneer, be consumed by inner doubt. Even the most confident person’s confidence can take a severe knock by, for example, being rejected by someone they are in a relationship with or suffer a run of bad luck and misfortune.

In social situations, if we see others around us behaving very confidently, it is worth reminding ourselves that this is quite possibly not a true reflection of how they feel inside – they may simply have learned to hide their inner anxieties.

However, because some people are very good at putting on a confident social mask, others tend to take them at face value and assume that they are as confident as they appear.

Perhaps one of the most powerful strategies for overcoming social anxiety is to take a leaf out of these people’s book and, in social situations, start to ‘act as if’ we are confident. We can ask ourselves how a confident person would enter a room, how they would move, how they would behave, how they would use body language and meet others’ gazes etc, and then act in a similar manner ourselves. Doing this has a very powerful effect – acting confidently actually leads us to feel confident. It also causes others to respond to us differently which instills further feelings of confidence and initiates a virtuous circle of feeling and behaving.

The ‘acting as if’ technique can be made even more effective if, as well as acting in a confident manner, we train ourselves to start thinking confidently in social situations as well. We can practice positive self-talk and give ourselves positive messages like ‘there’s no reason these people should dislike me’ or ‘these people don’t represent a threat to me’ etc.

By employing such strategies as the ‘acting as if’ technique, success builds upon success and results can begin to show surprisingly quickly.

Paradoxically, trying to relax can actually make some people feel more anxious and stressed, not less.

When I was extremely ill and in hospital (I was hospitalized on several occasions due to the seriousness of my condition), I was encouraged to attend certain therapeutic classes (which, because I was almost catatonic with severe clinical depression and anxiety, I most resolutely did not want to do – amongst other myriad other symptoms, I had no motivation whatsoever, together with an unshakeable belief that there was no possibility at all of me getting even very slightly better (such thinking is almost universal amongst the seriously, clinically depressed).

However, I eventually agreed to attend a class in which the therapist tried to guide me (and the other patients who had attended) through a relaxation exercise. Just a minute or so into the exercises, I felt so overwhelmed by anxiety that I had to excuse myself and leave the room, seeking, instead, refuge in the smoking room where I chain-smoked innumerable cigarettes.

In fact, this such a paradoxical reaction to an attempt to relax is not especially rare – a small percentage of those with anxiety will react in a similar manner.

So, what is the cause of this paradoxical response? Several ideas have been proposed, and I briefly look at some of these below:

POSSIBLE CAUSES OF A PARADOXICAL RESPONSE TO ATTEMPTS TO RELAX :

Trying to relax and ‘let go’ of stressful mental activity can induce in some individuals a feeling of loss of control. Related to this is the phenomenon whereby some people feel that, if they stop worrying about things, something terrible will happen and that their constant worrying is therefore somehow ‘protective’. Psychologists sometimes refer to such mistaken belief systems as ‘magical thinking’.

Fear of loss of identity – for some, being stressed (eg always busy, ‘driven’, ”keyed-up’ etc) forms part of their identity and they feel uncomfortable relinquishing this identity, fearing that if they do so others may see them as complacent, indolent etc rather than as the ‘dynamic’ individual they hope others perceive.

Brain wave activity – becoming relaxed correlates with a shift in brainwave activity from beta-waves to alpha-waves which may cause thinking to become cloudy, hazy and foggy; some individuals find this disconcerting.

Frustration – if we try to relax, and find we cannot immediately do so. this can lead to frustration which makes relaxation even more difficult; this can quickly develop into a vicious circle.

Fear – similarly to the above, we may fear we will not be able to relax (by thinking things like : ‘If I don’t relax soon, I’ll go completely and irreversibly insane’ – which was the kind of thing I used to think) thus putting too much pressure on ourselves. In this way, the fear that we will not be able to relax can rapidly become a self-fulfilling prophecy.

Depersonalization – relaxation techniques can lead to feelings of ‘depersonalization’ in some people. Depersonalization can manifest itself as feeling of being ‘detached from one’s body‘ or as being an ‘observer of oneself.’ Many find such a sensation unpleasant

Derealization – ‘derealization’ can manifest itself as a feeling that ‘the world is not real’ and more like a nebulous, hazy, dreamworld. Again, many find this unpleasant. (‘Dearealiztion’ is a type of ‘dissociation.‘)

Distraction – for some individuals, certain types of stress (such as always ‘keeping busy’) can operate as a distraction from problems and worries the person finds hard to face (in extreme cases, this may result in ‘workaholism‘). In this way, the stress/’keeping busy’ works as a psychological defense mechanism – the sudden dropping of this defense may lead to the person becoming vulnerable to being overwhelmed by floods of previously suppressed anxiety.

In response to the problem of the possible paradoxical effect a small minority of individuals may suffer as a result of trying to relax, some hypnotherapists have been trained in technique of inducing what is referred to as an ALERT TRANCE which some may find to be helpful.

Research shows that those who suffered significant trauma as children are at elevated risk of developing anxiety conditions as adults; simple phobias are one (amongst many) expression of such anxiety.

A simple phobia is an irrational fear of a single object, activity or situation (unlike complex phobias that may have multiple triggers, such as social phobia). The individual who has the phobia is fully aware that his/her phobia is irrational, but, despite this awareness, at the point of starting therapy has been unable to overcome it.

Research:

Whilst further research needs to be conducted on the effectiveness of hypnotherapy as a treatment for individuals suffering from simple phobias, several studies have shown it to be helpful (e.g. McGuinness, 1984; Rustvold, 1994).

How Is Hypnotherapy Used To Treat Simple Phobias?

One of the most effective ways of treating asimple phobia with hypnosis is to employ the method of desensitization and I explain the process below, using the example of arachnophobia (a phobia of spiders).

1) A deep sense of relaxation and safety is hypnotically induced in the patient.

2) The patient is instructed to visualize a small spider from a distance

3) The patient is instructed to visualize the same spider but from a closer distance

4) The patient is instructed to visualize an average sized spider from a distance

…etc…etc

The final stage might consist of the hypnotherapist instructing the patient to visualize picking a large spider up with a people piece of tissue paper and dropping it out of the window.

The idea is that at each subsequent stage the patient is gradually exposed, in imagination only, to increasingly, potentially anxiety-provoking ‘encounters’ with the spider. It is unnecessary for the patient to come into contact with a real spider.

Throughout the process, the client receives suggestions that s/he will feel relaxed, safe and in control.

When successful, this process has the effect of gradually and systematically ‘desensitizing’ the patient to spiders (i.e .causing the patient to stop responding fearfully to them in a way that is TRANSFERABLE TO REAL SITUATIONS).

Phobias, Logic And Reasoning:

Many individuals who suffer from phobias become frustrated that they are unable to overcome their phobia through logical and reasoned thinking given that they know their fear to be irrational; repeatedly telling themselves the object of their fears presents no threat or danger to them tends not to work which means cognitive based therapies may be unsuccessful.

When individuals try to cure their phobia by logic and reason they are using the brain’s left hemisphere.

However, the benefit of using hypnosis to treat phobias is that it taps into the brain’s right hemisphere and this side of the brain is involved in emotional processing, feelings, instincts and visualization, all of which hypnosis harnesses to help the individual overcome his/her phobia.

We have seen from previous articles that I have posted on this site that, if we suffered chronic stress during our childhood, our ability to deal with stress as adults can be drastically diminished, making it difficult to cope with the daily stressors that others may easily be able to take in their stride.

We may, for example, become disproportionately enraged if we temporarily misplace our keys, inadvertently snap a shoe-lace, or are thwarted in our vehicular progress down the street by a succession of obstinately and infuriatingly red traffic lights.

The reason for such overreactions can lie in the fact that our chronically stressful childhoods have disrupted the process in the brain associated with the production of stress hormones.

In particular, levels of the stress hormones adrenaline and cortisol may have become chronically too high.

It follows that, when we experience a minor stressor, too much adrenaline and cortisol are released. Let’s look at the effect that these two stress hormones have upon the body:

1) The Effect Of Adrenaline On The Body:

– causes heart rate to increase

– causes blood pressure to go up

– causes breathing rate to become more rapid (sometimes leading hyperventilation, a distressing reaction associated with panic).

2) The Effect Of Cortisol On The Body:

– transports energy to muscles by diverting it from areas of the body where it is not immediately needed (such as the stomach).

So, the effects of adrenaline and cortisol combined are to prepare the body for ‘fight or flight’, as if we were being threatened by a ravenously hungry tiger (when, in fact, we are just stuck in traffic or have mislaid our keys etc). In such a case, energy builds up in the body which is not dissipated, causing great tension.

Above: Over-reacting to minor stressors can be caused by chemical/hormonal inbalances resulting from a chronically stressful childhood.

In order to attempt to free ourselves from this unpleasant feeling of tension, we may try to partly dissipate it by shouting obscenities or pounding our fists against some wholly innocent inanimate object (this is sometimes referred to by psychologists as a displacement activity).

In other words:

We are responding to minor stressors as if they posed severe, even life-threatening, danger. Our brain is preparing us for fight or flight because it has grossly overestimated the risk the minor stressor poses to us. It is ‘fooled’ into making this error due to the disruption of the body’s system that produces adrenalin and cortisol caused by our chronically stressful childhood.

And, following the same logic, when we’re unfortunate enough to experience major stressful events in our adult lives, we may find ourselves going into nuclear meltdown, utterly overwhelmed and unable to cope.

GOLDEN RULES FOR DEALING WITH STRESS

According to the British Medical Association, the GOLDEN RULES OF STRESS MANAGEMENT are as follows:

1) Decide what is really important in life and concentrate upon that (i.e. develop a good sense of priorities).

2) If you know you have a difficult situation coming up, try to plan how you will deal with it in advance

3) Try to develop a supportive social network and discuss problems with others

7) Avoid brooding about problems – this is very important and you might need to distract yourself by doing something pleasant, rewarding and interesting

8) Try to think realistically about problems, keeping them in proportion. Where possible, TAKE DECISIVE ACTION to remedy them, rather than continuously having futile worries about them.

9) Be compassionate and forgiving towards yourself

10) Seek professional help if you feel you need it

11) Don’t over-exert yourself mentally or physically – rest and peace of mind are essential for proper recovery which will sometimes necessitate taking time off from work (taking time off work for psychological health reasons is just as valid as taking time off due to a physical problem).

12) Try to make small, frequent, positive changes – these soon mount up making a big difference

13) Make time for yourself – everyday.

14) Undertake as many enjoyable activities as possible.

HYPNOTHERAPY FOR STRESS :

Hypnosis can be combined with cognitive-behavioural therapy (CBT) to effectively help break the vicious cycle of anxiety. For many sufferers of anxiety, a vicious cycle of worry often develops which will often comprise the following five stages:

2) Specific automatic, apprehensive thoughts are triggered about what could happen

3) The individual switches into ‘anxiety mode’ with the accompanying unpleasant symptoms and bodily sensations

4) The individual experiences ESCALATING WORRY. This can include expecting a catastrophic outcome and assuming one is utterly helpless. As a result, maladaptive (unhelpful) avoidance, escape and safety seeking behaviours frequently take over.

5) Frantic attempts to control and/or eliminate the anxiety (paradoxically making it worse).

Why does trying to control and eliminate the anxiety paradoxically make it worse? This is due to something called the REBOUND EFFECT – by trying to exercise thought control, the unwanted thought tends to come back at us all the harder. In other words, when we try deliberately not to think about something, we can actually think of little else. For example, try very hard not to think of a pink elephant for the next 30 seconds and see what happens! Cognitive hypnotherapy can help us to overcome this problem by training us to ACCEPT our anxiety, which leads to it becoming less intense and less painful.

Another way cognitive hypnotherapy helps us to overcome our anxiety is to help us to ‘ACT AS IF’ we are not anxious. By thinking what we would be doing if we were not anxious, and then just doing it anyway, is a very effective way of loosening its grip.

Thirdly, cognitive hypnotherapy can help us to not get caught up and enmeshed with our worried thoughts – it does this by helping us to take a more DETACHED view of them (for more on the benefits of this, see my post on MINDFULNESS).

A fourth way cognitive hypnotherapy can help is allowing us to EMOTIONALLY REVIEW whatever it is we are worried about. In essence, this means IMAGINATIVELY EXPOSING ourselves repeatedly to what we are concerned about so we EMOTIONALLY HABITUATE to it – this emotional habituation to our concerns weakens feelings of anxiety connected to them.

Finally, cognitive hypnotherapy can help us see that our feelings are connected to our thoughts, and that our thoughts may be inaccurate and full of errors. The type of thinking errors that lead to anxiety and which cognitive hypnotherapy can help us to overcome are as follows:

a) PROBABILITY – anxious thinkers tend to greatly overestimate the probability of the bad outcomes they are expecting happening

b) SEVERITY – even if the feared outcome does actually occur, anxious thinkers tend to greatly overestimate how bad it will be

d) SAFETY – anxious people tend to overlook evidence that they will be safe from what it is that they are concerned about. Also, they often overuse maladaptive (unhelpful) safety behaviors, such as avoidance, which can, in the long-term, worsen the anxiety.

Some specific techniques cognitive hypnotherapy can help individuals develop which are very useful for reducing anxiety are as follows:

i) PERFORMANCE ACCOMPLISHMENTS – this technique helps the individual focus on times in the past when they HAVE COPED with something that caused them anxiety and realize that they can cope in the future too.

ii) VICARIOUS EXPERIENCE – here hypnotherapy is used to help the individual imagine how others have coped (or would cope) in a similar situation and then to imagine how they themselves could cope in a similar manner.

We have seen from several articles that I have already published on this site that if we have suffered significant childhood trauma we are at increased risk of suffering from crippling anxiety conditions in our adult lives.

Such anxiety conditions, unfortunately, may be intensified if we have certain personality characteristics. I briefly outline each of these characteristics below:

High Anxiety Personality (HAP) Traits (Characteristics):

1) Creativity/Imaginativeness:

Such individuals’ brains may ‘run wild’ when thinking about what could go wrong in their lives; hence, of course, the expression, ‘You’re letting your imagination run away with you.’

2) Excessive Need For The Approval Of Others:

Such an individual is extremely dependent upon the approval of others in order to sustain self-esteem as s/he lacks the requisite internal, psychological resources to sustain it by him/herself.

Those with this extreme need for approval often deeply fear rejection and find it very hard indeed to accept criticism from others.

They may, too, constantly feel compelled to meet the needs of others (or to perpetually be what is colloquially known as a people-pleaser).

– tends to become obsessive about small flaws in tasks s/he undertakes, detracting from concentration on the ‘big picture’ in relation to what s/he wishes to achieve

– tends to see outcomes of tasks s/he has undertaken in ‘black and white’ terms, ignoring all of the ‘shades of grey’ in between; to the perfectionist, the outcome of a task is either a success or a failure. For example, a student may regard getting a grade ‘B’ rather than a grade ‘A’ as a ‘failure’, thus ignoring the fact that getting a grade ‘B’ is itself a very worthwhile achievement which many other students (non-perfectionists) would be quite content with.

4) Excessive need to be in control:

Those with an excessive need to be in control tend to have a very high need for life proceeding in an orderly, structured, predictable and routine manner, and to become very anxious when unpredictable events intervene. Frequently, also, they feel a strong need to control those around them.

Whilst they may experience a high level of anxiety and distress when events conspire to undermine their ability to control their environment, they may, nevertheless, be very adept at hiding such internal feelings from others, giving the impression of being an extremely strong individuals.

5) Excessessive need to be in control of their negative emotions:

For example, they may feel it is somehow ‘wrong’ to ‘indulge in’ negative emotions such as sadness and anger and, therefore, subjugate and suppress such natural feelings that are, of course, common to all humanity.

However, this is not healthy. The suppression of anger, for example, can cause it to build up over time, eventually erupting in a manner that is totally disproportionate to the trigger (or, to use a very well known expression, the straw that broke the camel’s back). Also, research suggests that the suppression of anger can also impair physical health, contributing to:

As a child, from the age of about ten, my brother ( three years older than me) never called me by my name, but always referred to me as ‘Scabby’ or ‘The Scab’. When, at age and eleven, I joined him at secondary school (Watford Grammar School for Boys, Hertfordshire, UK, just in case anyone’s remotely interested) he ensured all his friends knew this name for too, with all too predictable results.

The reason (apart from their flagrant and wholly gratuitous ignorance) was that I compulsively picked at my skin. I have since discovered that this is a recognised disorder with various medical names, including:

It is also theorised that it can operate as an expression of repressed rage and/or other repressed feelings.

In nearly half of all cases the onset of the disorder occurs before the age of ten years. It is linked to childhood abuse and trauma and is often accompanied by depression, anxiety and obsessive thoughts.

Genes are also thought to play some part in the disorder.

Severe cases.

In severe cases, individuals can spend hours a day picking at their skin and the harm inflicted can be so severe that skin grafts are required.

Also, as can well be imagined, heavy scarring can result (as it has in my case).

Link To Suicide:

Particularly worryingly, about 11% of those who suffer from the disorder will attempt suicide.

To compound the problem, those who suffer from the disorder often feel ashamed of their compulsion and, accordingly, do not want others to know. Because of this, they often select areas of skin to pick which are not normally on show to the public (eg see picture above).

Treatment:

More research is needed to ascertain effective treatments but two of the most promising at the moment are cognitive behavioural therapyand habit reversal training.

Separation Anxiety And The Insecure Child

When I was twelve years old I went on a French exchange with my school. This involved me staying with a French family for a fortnight. Although they were all perfectly nice people (from what I could make out from my extremely limited ability to communicate with them) I became extremely homesick (even though my home life was very unhappy, but such is the paradoxical nature of the condition) and cried everyday, insisting I telephoned my mother. The parents of my French exchange partner were very tolerant,and, despite the cost, permitted me to do this uncomplainingly.

Then, when I was seventeen (I was now living with my father and step-mother), I was due to go on an American exchange trip ( this time for a whole month) but developed a mysterious fever a couple of days before I was due to go which was serious enough for my doctor to instruct me that I would be unable to travel.

Developing physical illness as a child in response to anticipated or actual separation from home is a classic symptom of a childhood psychiatric condition known as separation anxiety.

Before I talk about this condition more generally, here is one last example of how I manifested this form of anxiety as a very young child (long before the two examples given above occurred). Apparently, if I was out walking (or, in my case, toddling) with my mother and it was windy, I would become very frightened, hysterically so, in fact, that I would be physically blown away and would hold onto my mother’s (frigid) hand as if my very life depended upon it. This represents another classic example of separation anxiety.

Above: How I might have looked being carried off by the wind as a toddler and my mother’s likely obliviousness to the fact.

I have other examples, but these three will, I think, suffice for now.

How Common Is Separation Anxiety?

Separation anxiety is the most prevalent type of childhood anxiety condition (other types include obsessive-compulsive disorder, phobia, social anxiety and generalised anxiety disorder).

Approximately 1 in 20 children will suffer from it at any given time and females are more likely to be affected by it than males, all else being equal. The disorder is most likely to manifest itself when the child is between about 7 and 9 years of age but can also develop in children as young as 2 years old as well as in adolescents as old as seventeen years (myself being a case in point).

What Causes Separation Anxiety?

The condition can occur in response to traumatic, early childhood experiences such as the mother not being reliably available (physically, emotionally or both) during the child’s babyhood. Also, it can manifest itself after a major traumatic family event such as parental divorce or life-threatening illness of a parent. Also, if a child is emotionally insecure and feels deprived of love, attention and protection, the condition is also much more likely to develop. Finally, it is likely that certain genetic and biological factors can make a child more susceptible to the adverse effects of early stressors like those described and, therefore, such a child is at increased risk.

How Is Separation Anxiety Diagnosed?

As the name of the condition suggests, a child who suffers from it displays severe anxiety if s/he has to separate from his/ her primary care-giver for a period of time (or anticipates having to do so). For a formal diagnosis (and that can only be made by a properly qualified and experienced professional) the level of anxiety the disorder gives rise to in the child must cause him/her significant distress. A further stipulation for a formal diagnosis is that symptoms of the condition must have been present for a minimum time period of 4 weeks.

What Specific Symptoms Can Separation Anxiety Produce?

A child who is suffering from separation anxiety may:

– exhibit extreme homesickness when away from home

– refuse to be left alone in a room

– refuse to sleep in a room alone

– suffer nightmares that centre around themes of abandonment, rejection and separation from caregivers

– exhibit extreme distress when separated from primary caregivers or when anticipating such separation

– refuse to go to school

– continually follow the primary caregiver around the house

– exhibit fear of primary caregivers dying or becoming seriously ill even when they are perfectly healthy

– display a constant need to know where parents are

– become extremely distressed if primary caregivers are late arriving home

Separation anxiety can only be diagnosed and treated by appropriately qualified and experienced professionals. Available treatments include cognitive behavioral therapy and certain medications. In the UK, the first port of call is likely to be a GP or school psychologist/ counselor.

As I explain elsewhere on this site, those of us who have experienced significant childhood trauma are more likely to suffer from anxiety as adults than those who were spared such adverse experience (all else being equal). Severe anxiety is devastating and utterly debilitating. Indeed, in my own case I was almost unable to function at all, even in the most basic areas of life such as washing, shaving, having a conversation (I became almost monosyllabic) and shopping for food (I would frequently rely on having takeaways delivered to my flat) as well as feeling constantly, unremittingly suicidal.

When in such a state, it can feel almost impossible to help oneself and professional help, medication and possibly hospitalisation may be required (as it was in my own case). However, when anxiety is not totally paralysing or when we have recovered from an anxiety condition and wish to prevent relapse there are certain things we can do to help ourselves. I outline ten of these below:

1) Modelling : this involves thinking of someone we know personally or someone in the public eye whom we admire in relation to their ability to cope with stress and overcome adversity. We can then use this person as a role model; for example, when we find ourselves in an anxiety provoking situation we may ask ourselves how the person we have selected as our model would respond and then try to emulate such a response.

2) Altruism : e.g volunteering/ charity work – perhaps a contradiction in terms, but benefits of altruism (there is not room in this article to go into whether ‘pure’ altruism can actually exist) can include distracting ourselves from our own concerns, getting our own difficulties into a better perspective and generally raising our own opinion about ourselves.

3) Take time to enjoy leisure activities (and stop feeling guilty about it) : one unhealthy attitude that high anxiety can lead to is perfectionism which can manifest itself in various ways, a common example being so-called ‘workoholism’. We can fall into the trap of trying, obsessively, to reach the pinnacle of success in all that we undertake (or as much success as our talents will permit). However, paradoxically, we are likely, overall, to be more productive and efficient if we allow ourselves guilt-free time to simply enjoy ourselves. The alternative may be utter exhaustion, burnout and psychological breakdown and/or stress induced physical illness.

4) Look after our physical health – including ensuring that we get enough sleep ( having to work when tired can feel tortuous and is highly stressful).

5) Pursue that which is meaningful to us : sometimes we can become so caught up in what society or other people expect from us and with the daily struggle merely to keep our heads above water that we fail to stand back and examine whether we are finding our lives fulfilling and meaningful. Instead, we live in a kind of fog, preoccupied merely with existing and surviving, that prevents us from seeing life’s potential.

It can be life changing and, indeed, life-affirming, to consider if we would benefit from altering our direction in life in such a way that it becomes more aligned with our values. This could involve, for example, retraining to enable us to undertake a career that we find truly rewarding – a vocation as opposed to a job. We then need to make such a change feasible (see item number 6 beneath the chart).

Above-how the typical person spends time worrying.

6) Taking small steps: once we have decided what we would like to do in order to make our lives more meaningful, we can then set up a plan that will facilitate this. Often, so that we do not feel overwhelmed, it can be best to break the ultimate goal down into a series of more modest subgoals. It is then useful to set ourselves a timetable of by when we would like each small step to be completed. Each step needs to be realistic and achievable and we need to plan in advance how each small step can be achieved. The timescale we give ourselves to achieve our ultimate goal is up to us – for instance, we may have a one year plan, five year plan or even ten year plan.

7) Practice mindfulness : there is now very strong scientific evidence that learning mindfulness is an extremely effective way to reduce anxiety

8) Restart an old hobby : if we become very unwell with anxiety and depression it can stop us doing things that we used to enjoy (indeed, we can develop a condition that prevents us from enjoying anything called anhedonia – click here to read my article about this). However, doing nothing and just sitting at home (or lying in bed) negatively ruminating perpetuates the problem. Whilst it can seem almost impossible, taking up hobbies we used to enjoy before we became ill can help to kick-start some significant, positive change (the potential to enjoy these activities is still there, however we may feel).

9) Take up anew hobby : the rationale here is the same as above

10) Connect with nature : a walk in the woods or other natural environments can be surprisingly therapeutic – the effect can be very soothing. A camping trip could be especially beneficial.

Research suggests that those who suffer from severe anxiety conditions have brains which are different in terms of structure, chemistry and biology compared to the brains of those individuals who are fortunate enough not to suffer from such a debilitating affliction.

To date, research has provided evidence for the following differences:

1) Those who suffer from severe anxiety tend to have lower levels of the chemical serotonin(also known as a neurotransmitter) available in their brains than average (research has found that this also tends to be true of individuals suffering from clinical depression).

This theory of serotonin deficiency is supported by the fact that medications that increase the level of serotonin in the brain, such as the selective serotonin reuptake inhibitors (SSSRIs) class of anti- depressants can effectively ameliorate the symptoms of anxiety.

2) Those who suffer from severe anxiety tend to have lower levels of the amino gamma-aminobutyric (GABA) available in their brains compared to average.

GABA’s function is to calm and quieten brain activity ; when there is too little of it, research suggests it can lead to:

– difficulties sleeping/insomnia

– feelings of agitation/inability to relax/restlessness/ jitteriness

– ‘out of control’ thoughts/ racing thoughts

– a general feeling of anxiety/nervousness

This theory is supported by the research finding that benzodiazepines, which increase the effectiveness of GABA in the brain, can help to alleviate the symptoms listed above. Unfortunately, however, this medication is addictive and (here in the UK, at least) doctors are very reluctant to prescribe it, particularly for more than a very short period of time (a week or two, in my own personal experience).

3) Those who suffer from severe anxiety, research using brain scans have revealed, can show abnormalities in both the structure and functioning of their brains.

Physical differences in brains of those who have PTSD as a result of severe stress. PTSD can develop as a result of severe childhood trauma.

For example, individuals suffering from severe anxiety have been found to possess smaller amygdalae and hippocampae (these are both brain structures involved in the experience of anxiety) than normal, one cause of which is thought to be as a result of the development of these two brain structures being adversely affected in childhood due to the suffering of severe trauma (click here to read one of my articles on this).

Indeed, one study found that those who had suffered severe childhood trauma had hippocampae which were only, on average, about seventy-five per cent the size of normal hippocampae.

ANXIETY AND NEUROTRANSMITTERS :

Many individuals who suffer from anxiety take prescribed medication for it. This is because anxiety is linked to the imbalance of various neurotransmitters in the brain and medications can sometimes helpfully correct such imbalances (though, like any treatment for anxiety, they do not work equally well for everyone – indeed, in my own case, very few medications I have ever taken for anxiety have had any beneficial effect whatsoever).

What Are Neurotransmitters And What Is Meant By ‘Out Of Balance’?

The brain contains about 10 billion neurons (brain cells). Each of these can potentially communicate with 10,000 other neurons. This communication is carried out by the brain’s neurotransmitters and this communication gives rise to how we think, behave and feel.

When neurotransmitters become out of balance, it simply means that there is an excess or insufficiency of them being produced in the brain. The effect of such an imbalance can cause us problems relating to how we think, behave and feel.

In this article, I want to look at the main neurotransmitters in the brain that are found to be out of balance in those suffering from an anxiety disorder; they are :

SEROTONIN

DOPAMINE

NOREPINEPHRINE

GABA (gamma aminobutyric acid)

GLUTAMATE

What Symptoms Are Caused By Imbalances Of The Above Neurotransmitters In The Brain?

imbalance which can, in turn, exacerbate an imbalance in other neurotransmitters

As stated above, medication prescribed to help correct the imbalance of neurotransmitters does not work equally well for everyone. Non-drug methods of treating anxiety which can be effective include :

COGNITIVE BEHAVIORAL THERAPY (CBT)

MINDFULNESS MEDITATION

BREATHING EXERCISES

HYPNOTHERAPY / COGNITIVE HYPNOTHERAPY (see below)

HYPNOTHERAPY AND ANXIETY :

In cases where medication does not work or is inappropriate, hypnotherapy can be an effective treatment for anxiety. The relaxation that hypnosis induces can significantly reduce both emotional arousal and the physiological arousal which invariably accompanies it.

Well controlled research studies (e.g. Weldon et. al.) have demonstrated that the more hypnotizable an individual is, the better their outcome when being treated for anxiety. Anxiety is related to PERSISTENT NEGATIVE THOUGHTS, in particular the constant anticipation that the worst is likely to happen.

Such thoughts are often of the ‘what if…’ type, leading to the imagination conjuring up all kinds of dire predictions (the anxious individual will almost invariably vastly overestimate the chances of the worst happening AND underestimate his/her ability to cope should the worst occur. However, I know from my own experience that the fear such thinking creates is very real and can lead to severe distress).

Examples of the kinds of thoughts the anxious individual may experience are :

– ‘ what if my partner leaves me? – I’ll die lonely and unhappy.’

– ‘ what if I lose my job? – I’ll be on the streets and have to obtain my meals from garbage cans.’

– ‘ what if this new mole on my hand is skin cancer? – I’ll be dead within a month and die horribly, or else my hand will be amputated and my juggling career will be severely hampered.’

The term for this kind of thinking, you will not be surprised to discover, is CATASTROPHIZING. Such thinking processes are often deeply ingrained in those who suffer anxiety; indeed, such catastrophizing can become intrusive and obsessive causing, as I have said, considerable anguish. My own anxiety required that I was sometimes hospitalized.

THE ROLE OF HYPNOSIS. When we are anxious, a vicious circle can develop : our negative, even paranoid, thinking causes us to experience adverse physiological symptoms (e.g. sweating, dizziness, tremors, dry mouth, stomach upsets, physical tension, restlessness etc) and these symptoms, in turn, intensify our negative thinking. In this way the mental and physiological symptoms feed off one another in a king of anti-symbiotic relationship.

Hypnosis can address both of these categories of symptoms in a two-pronged attack – it can reduce negative thinking and encourage their replacement with more realistic, positive thoughts by utilizing a technique, based upon the psychologist, Beck’s, cognitive behavioral therapy model (click here to read my article on this) AND training the individual to use powerful, physical relaxation techniques.

However, acquiring the new skills requires several hypnotherapy sessions, which is why a good hypnotherapist will provide the client with a recording of the session so that s/he (the client) can repeatedly listen to it at home, thus making it more likely the new skills will take permanent root in his/her mind.

– HYPERVIGILANCE : constantly feeling in great danger, and, therefore, always being on ‘red alert’, making relaxation impossible (I myself was in such a state for at least three years without respite and I can therefore attest to the excruciating mental agony such a state can entail)

– SELECTIVE ABSTRACTION : this refers to when we exclusively focus on just the negative side of the situation we find ourselves in

– IRRATIONALITY/LOSS OF PERSPECTIVE : this can involve greatly overestimating the odds of what we fear actually happening. Again, I was in such a state for a long period of time which I think must have extended, at times, into the realms of clinical paranoia. Absolutely horrible.

– DICHOTOMOUS THINKING : this refers to seeing things in extremes and is sometimes referred to ‘black and white’ thinking, so things are viewed as ‘all good’ or ‘all bad’ which leads to the exaggeration, in our minds, of negative events, circumstances and situations.

Hypnosis can help by positively modifying these kinds of faulty-thinking styles and also be inducing relaxation. Some specific techniques employed by cognitive hypnotherapy are outlined below :

1) AGE PROGRESSION : this involves getting the client, in the hypnotic state, to visualize him/herself in a future situation which s/he currently fears and then imagine him/herself coping well with it

2) RESTRUCTURING COGNITIVE CORE BELIEFS : Beck and Emery (1985) identified a number of unhelpful fundamental or core beliefs that the individual prone to pathological anxiety was likely to hold (such a maladaptive belief system almost invariably stems from adverse childhood experiences). Examples of such anxiety inducing core beliefs (and for many such core beliefs will be acting on an unconscious level) include :

a) ‘I should regard any strange situation I find myself in as dangerous’

b) ‘ I should always expect the worst will happen’

c) ‘I am constantly in serious danger’

The psychologist Leahy (1996) expands upon this and puts forward the view that underlying anxiety are a sense of :

a) Threat

b) Imminent loss or failure

c) Imminent, or current, loss of control over one’s own life

Dowd (1997) outlines ways in which hypnosis can help us to cognitively restructure our unhealthy core beliefs :

REPLACEMENT AND COPING IMAGERY : Once the individual is in the hypnotic trance state it is suggested to them that they imagine themselves in a feared situation, such as being reprimanded by a superior at work. It is then suggested to them that any anxiety this induces will quickly dissolve and be replaced by feelings of competence and of being in control, together with an acceptance that no one is perfect so there is no need to feel one’s confidence has been significantly undermined.

HYPNOTIC COGNITIVE REHEARSAL : This involves repeatedly imagining, under hypnosis, performing well in a feared situation, such as an upcoming social event ( a similar technique is used in sports psychology, whereby, for example, a tennis player will have been trained to vividly imagine a successful serve – exactly where to place the ball etc – before executing the shot).

Hyperventilation (deriving from HYPER = TOO MUCH and VENTILATION = AIR MOVEMENT) refers to a type of breathing which is too deep and too rapid.

Such breathing results in :

1) too much oxygen

and

2) too little carbon dioxide

entering the blood stream.

Indeed, severe hyperventilation can result in the amount of carbon dioxide in the blood stream falling by 50℅ within sixty seconds.

Why is a reduction of the amount of carbon dioxide in the blood undesirable?

A significant reduction of the normal amount of carbon dioxide circulating in the blood stream is undesirable because it raises the pH levels in nerve cells.

This, in turn, makes the nerve cells too excitable and can trigger the fight/flight response (click here to read my article about this). The physiological effect of this can then lead to symptoms such as those I list below:

Such symptoms of anxiety can occur very quickly once we start to hyperventilate ; within a minute, in fact.

Lack of awareness:

Many people whose anxiety is linked to the fact that they hyperventilate do not realise that their maladaptive breathing style is significantly contributing to their symptoms. Indeed, many do not realise that they are hyperventilating. I myself hyperventilated for years without being properly aware of the fact and without fully appreciating how important it is to train oneself to stop doing it. I suppose an (irrational) part of me felt that such a simple change could not make a significant difference to how I was feeling.

Two main types of hyperventilation:

These two types are:

1) At rest, breathing from the upper chest instead of from the diaphragm

2) At rest, breathing through the mouth instead of the nose

Many people who suffer from anxiety breathe from the upper chest whilst at rest. Whilst breathing from the upper chest is normal when we are in imminent danger (as it prepares us for ‘ fight or flight’ by introducing extra oxygen into the blood stream) and evolved to help our distant ancestors avoid danger from predators (eg by feeding muscles with extra oxygen to help them run away from the threat as fast as possible), such breathing was designed by evolution to be a temporary response triggered by a life-threatening, physical danger – so it only rarely serves a useful purpose for us today.

On the contrary, in fact, continuous, chronic breathing in this way can effectively permanently trap us in the ‘ fight/flight’ response.

This, in turn, can lead us feel under threat, nervous, fearful and in danger chronically.

Examples of conditions to which hyperventilation can be particularly relevant:

A person with social phobia may have their tendency to hyperventilate triggered by stressful social situations. The hyperventilation, in turn, will lead to increased symptoms of anxiety which can then result in the person’s hyperventilating becoming more severe still. In this way, a vicious cycle can develop (see below).

2) PTSD/flashbacks:

A similar vicious cycle may occur when anxiety symptoms are triggered by a flashback.

3) Panic disorder:

In extreme cases, the vicious cycle of anxiety/panic can increase symptoms of anxiety to a level at which a panic attack occurs.

Based on the science above, some people find that breathing into a paper bag helps when experiencing a panic attack, as doing so increases carbon dioxide levels in the blood stream and returns them to normal.